Discussion Title: Is Covid-19 more dangerous than regular flu viruses?

1. Covid-19 is much more dangerous than regular flu viruses.
1.1. Pro: Covid-19 poses a greater risk than the flu for those without access to vaccines.
1.1.1. Con: Various companies have successfully developed vaccines and treatments.
1.1.1.1. Pro: A vaccine would normally [take years](https://www.bbc.com/news/health-51665497), if not decades, to develop, which illustrates the urgency with which governments and pharmaceutical companies worked to tackle Covid-19.
1.1.1.1.1. Con: In the time it took to develop vaccines, a significant number of people lost their lives.
1.1.1.1.1.1. Con: People who are dying from Covid-19 [are oftentimes](https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html) old, have other severe illnesses, and have a weak immune system. They would have likely died from diseases like seasonal flu which also attack people with weak immune systems.
1.1.1.1.1.2. Pro: The [first vaccine shot](https://www.bbc.com/news/world-us-canada-55305720) for Covid-19 was administered on 14 December 2020. By then, [1,685,371](https://covid19.who.int) people had already died of Covid-19.
1.1.1.1.1.3. Pro: Even after the vaccine had been developed, countries faced significant logistical and organizational issues that have impeded people's ability to access the vaccine. Slower vaccine rollout has [prolonged the pandemic](https://www.euro.who.int/en/media-centre/sections/press-releases/2021/slow-vaccine-roll-out-prolonging-pandemic) and thus lead to more deaths.
1.1.1.1.1.3.1. Pro: The intricacies of [transport and storage](https://www.maersk.com/news/articles/2021/01/29/the-challenges-of-the-covid-19-vaccine-global-distribution) complicate the rollout of the vaccine.
1.1.1.1.1.3.2. Pro: Due to [supply chain issues](https://www.wsj.com/articles/pfizer-slashed-its-covid-19-vaccine-rollout-target-after-facing-supply-chain-obstacles-11607027787), Pfizer has announced that it will only be able to rollout half its expected volume of the vaccine in 2021.
1.1.1.1.1.3.3. Pro: Coordinating the vaccine distribution plan has proven to be [a challenge](https://penntoday.upenn.edu/news/logistics-covid-19-vaccine-rollout), particularly in countries that do not have a central healthcare registry.
1.1.1.2. Pro: As of March 23, 2021, there were [79 vaccines](https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html) in trial, with seven approved for full use.
1.1.2. Pro: Preventing people from contracting Covid-19 becomes extremely difficult without a vaccine.
1.1.2.1. Con: This situation is similar to one where a new flu virus strain is emerging and the existing flu shots are not effective anymore.
1.1.2.1.1. Con: New flu viruses emerge each year, but unlike Covid-19, these variants don't kill [hundreds of thousands](https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm) of people in the US.
1.1.2.2. Con: Even with vaccines, [100% protection](https://www.health.com/condition/cold-flu-sinus/how-effective-is-the-flu-shot) from either the flu or Covid-19 is not guaranteed.
1.1.2.2.1. Pro: Even those who are vaccinated [can spread](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058279/) the virus.
1.1.2.2.1.1. Pro: Covid-19 vaccines can help keep symptoms at bay but [do not](https://www.nytimes.com/2020/12/08/health/covid-vaccine-mask.html) necessarily stop the transmission of the virus as viral particles persist in the nose and throat.
1.1.2.2.1.2. Con: The [CDC has established](https://fortune.com/2021/04/01/its-official-vaccinated-people-dont-transmit-covid-19/) that it is highly unlikely that those who have been vaccinated will be able to transmit Covid-19.
1.1.2.2.2. Con: 100% protection is only guaranteed by the total [eradication](https://en.wikipedia.org/wiki/Eradication_of_infectious_diseases) of the virus, which is not the purpose of vaccines. Rather, the purpose is to manage the outbreak's [uncontrolled spread](https://graphics.reuters.com/CHINA-HEALTH-MAP/0100B59S39E/index.html) to managable levels.
1.1.2.2.3. Pro: New variants of Covid-19 could be relatively more resistant to [vaccines](https://www.nature.com/articles/d41586-021-00728-2).
1.1.2.3. Pro: This is evidenced by the [rampant spread](https://graphics.reuters.com/CHINA-HEALTH-MAP/0100B59S39E/index.html) of Covid-19 throughout the world.
1.1.2.4. Pro: Many people are unwilling to follow guidelines that help prevent the spread of Covid-19.
1.1.2.4.1. Pro: One study [found](https://dornsife.usc.edu/news/stories/3388/understanding-coronavirus-in-america-mask-use-among-us-adults/) that only half of American adults wore masks when in close contact with others outside their home.
1.1.2.4.1.1. Pro: There have been [multiple](https://nypost.com/2021/01/05/covid-19-anti-masker-issues-plea-from-hospital-bed/) [reports](https://www.usnews.com/news/best-states/montana/articles/2020-10-29/former-anti-masker-urges-caution-after-contracting-covid-19) of anti-maskers contracting the virus and then admitting they were wrong to not follow health guidelines.
1.1.3. Con: The risk is [rather low](https://www.kff.org/coronavirus-covid-19/issue-brief/how-many-adults-are-at-risk-of-serious-illness-if-infected-with-coronavirus/) for the vast majority of people testing positive for Covid-19, with [only 2%](https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html) needing intensive care.
1.2. Pro: Covid-19 infections can [overwhelm health systems](https://www.bmj.com/content/372/bmj.n83) due to the sharp increase in people requiring hospitalization and respiratory support.
1.2.1. Pro: Covid-19 is more infectious than the regular flu, so it infects a greater number of people overall. This increases the number of people requiring medical resources.
1.2.1.1. Pro: Disease experts estimate that each Covid-19 sufferer infects between [2 to 3 others](https://www.bangkokpost.com/learning/easy/1877259/no-coronavirus-isnt-the-same-as-the-flu).
1.2.1.1.1. Pro: That's a reproduction rate up to [twice](https://www.sciencealert.com/the-new-coronavirus-isn-t-like-the-flu-but-they-have-one-big-thing-in-common) as high as seasonal flu, which typically infects [1.3 new people](https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-480) for each patient.
1.2.1.1.2. Con: The rate of spread alone does not prove how dangerous a virus is.
1.2.1.1.2.1. Pro: Only when the propagation rates of viruses are coupled with their corresponding death rates per infected person is it possible to [compare their dangerousness](https://wwwnc.cdc.gov/eid/article/19/1/12-0124-f2).
1.2.1.1.2.1.1. Pro: If the rate of spread alone was used as a [measure of risk](https://www.cdc.gov/flu/pandemic-resources/national-strategy/risk-assessment.htm), HIV could be seen as [less dangerous](https://www.cdc.gov/flu/pandemic-resources/monitoring/irat-virus-summaries.htm) than the flu because of its low propagation rate.
1.2.1.1.2.1.2. Con: The rate of spread is relevant to a virus' ability to overrun healthcare systems if the hospitalization rate is high, even if the death rate is low.
1.2.1.2. Pro: A person with [Covid-19](https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm) may be contagious for a longer period of time than a person with the flu.
1.2.1.2.1. Pro: A person with Covid-19 may infect others for up to [ten days](https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html#:~:text=Assessment,-Duration%20of%20Isolation&text=Available%20data%20indicate%20that%20adults,10%20days%20after%20symptom%20onset.) after developing symptoms, while a person with the flu will remain infectious for [5-7 days](https://www.cdc.gov/flu/about/disease/spread.htm#:~:text=When%20Flu%20Spreads&text=Most%20healthy%20adults%20may%20be,for%20longer%20than%207%20days.) after developing symptoms.
1.2.1.3. Pro: Increased [transmissibility](https://www.medrxiv.org/content/10.1101/2020.12.24.20248822v1.full) of Covid-19 is likely to lead to an increase in hospitalisations.
1.2.1.3.1. Pro: Some new [variants](https://www.medrxiv.org/content/10.1101/2020.12.24.20248822v1.full) of Covid-19 are likely to lead to greater hospitalization rates because they are more transmissible than the other variants.
1.2.2. Pro: A study in [December 2020](https://www.bmj.com/content/371/bmj.m4677) found that, compared with the influenza virus, Covid-19 was associated with increased health resource use.
1.2.2.1. Pro: Patients with [Covid-19](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext) are more likely to need intensive care.
1.2.2.1.1. Pro: Covid-19 patients are more often treated with [vasopressors and renal replacement therapy](https://www.nature.com/articles/s41598-021-85081-0) than influenza patients.
1.2.2.1.2. Pro: Hospitalized [Covid-19](https://www.nature.com/articles/s41598-021-85081-0) patients have a more frequent need for oxygen therapy and invasive ventilation than patients with influenza.
1.2.2.2. Pro: Patients with Covid-19 are likely to stay in intensive care units for [twice longer](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext)(Patients with COVID-19 were more likely to need intensive care, and the mean length of stay in the ICU for COVID-19 was twice as long) than patients with the flu.
1.2.2.3. Pro: In January 2021, there were more patients with Covid-19 in London's acute [hospitals](https://www.hsj.co.uk/acute-care/exclusive-half-of-londons-hospital-patients-have-covid-19/7029317.article) than patients without Covid-19.
1.2.3. Con: Covid-19 cases would be less likely to overwhelm health systems if the systems weren't already dysfunctional in many countries.
1.2.3.1. Pro: India's healthcare infrastructure has been chronically [underfunded](https://www.livemint.com/news/india/how-covid-19-pandemic-exposed-india-s-chronic-underinvestment-in-healthcare-11597670943972.html) and [unequal](https://scroll.in/article/981694/coronavirus-the-poor-health-infrastructure-in-indias-scheduled-areas-failed-its-adivasis) for many years.
1.2.3.1.1. Pro: India's [enormous spike](https://www.worldometers.info/coronavirus/country/india/) in cases and deaths in April 2021 was exacerbated by [poor management](https://www.theguardian.com/world/2021/apr/22/covid-19-india-response-to-second-wave-is-warning-to-other-countries) and [supply shortages](https://www.bbc.com/news/56876695).
1.2.3.2. Pro: The US [healthcare](https://www.theatlantic.com/health/archive/2018/06/the-3-reasons-the-us-healthcare-system-is-the-worst/563519/) [system](https://www.ft.com/content/05f7fa82-a315-11e9-a282-2df48f366f7d) was broken long before the Covid-19 pandemic.
1.2.3.2.1. Pro: Even on normal days, hospitals in the US are [nearly at capacity](https://www.washingtonpost.com/opinions/2020/03/15/hospitals-are-overwhelmed-because-coronavirus-heres-how-help/). A Covid-19 outbreak was bound to overwhelm such limited resources.
1.2.3.3. Con: Many European countries that have [highly ranked](https://worldpopulationreview.com/country-rankings/best-healthcare-in-the-world) healthcare systems experienced great difficulties during the pandemic.
1.2.3.3.1. Pro: Hospitals in France have repeatedly been [overwhelmed](https://www.usnews.com/news/world/articles/2021-03-31/frances-macron-to-address-country-on-covid-19-situation)(An operation to transfer intensive care patients from overloaded hospitals to lesser-hit regions and a full lockdown in the hardest-hit parts of France had also been discussed), leading to large scale lockdowns.
1.2.3.3.2. Pro: Italy, the healthcare system of which is widely considered world-class, was pushed to its [breaking point](https://www.nbcnews.com/health/health-news/italy-has-world-class-health-system-coronavirus-has-pushed-it-n1162786) due to the healthcare demands created by the Covid-19 pandemic.
1.2.3.3.3. Pro: Healthcare systems in Belgium, Italy, Spain and the United Kingdom [suffered greatly](https://www.oecd-ilibrary.org/docserver/85e4b6a1-en.pdf?expires=1618074367&id=id&accname=guest&checksum=6EE290AB0259712AECFF3BCA4EBFBD7C) due to the pandemic \(p. 68\).
1.2.3.3.3.1. Pro: The NHS in the UK has been [overburdened](https://www.bmj.com/content/368/bmj.m1117/rapid-responses) due to the pandemic.
1.2.3.3.4. Con: [Countries](https://www.movehub.com/blog/best-and-worst-covid-responses/) that had strong public heath responses were able to contain Covid-19 infections relatively successfully.
1.2.3.4. Con: Increased hospitalization of Covid-19 patients due to a malfunctioning heath system still entails that it is dangerous, even if only contingently so.
1.2.4. Con: Hospitals have previously been overwhelmed by influenza patients as well.
1.2.4.1. Pro: There was a [flu epidemic](https://time.com/5107984/hospitals-handling-burden-flu-patients/) in the US in 2017-2018, which overwhelmed hospitals in nearly every state.
1.2.4.1.1. Pro: Many hospitals were forced to [treat patients](https://time.com/5107984/hospitals-handling-burden-flu-patients/) in tents.
1.2.4.1.2. Con: [61,000 people](https://www.cdc.gov/flu/about/burden-averted/2017-2018.htm#:~:text=CDC%20estimates%20that%20influenza%20was,severe%20seasonal%20influenza%20can%20be.) died as a result of this epidemic. In comparison, [350,000](https://usafacts.org/articles/preliminary-us-death-statistics-more-deaths-in-2020-than-2019-coronavirus-age-flu/) people lost their lives to the COVID-19 pandemic in 2020.
1.2.4.2. Pro: In 2013, many hospitals in the US were [overwhelmed by flu cases](https://fox8.com/news/flu-outbreak-overwhelms-area-hospitals/).
1.2.4.3. Pro: In 2017, hospitals in France [were overwhelmed](https://medicalxpress.com/news/2017-01-french-hospitals-overwhelmed-flu-epidemic.html) by the flu epidemic.
1.2.4.4. Con: The early phase of the [Covid-19 epidemic](https://www.nature.com/articles/s41598-021-85081-0) was associated with a higher demand for both critical care and regular care hospital beds than seasonal influenza epidemics with similar numbers of infection.
1.2.4.5. Pro: In 2018, a [flu epidemic](https://www.dailymail.co.uk/health/article-5237211/NHS-struggles-cope-flu-takes-Britain.html) in the UK led to a surge in cases at hospitals and clinics.
1.2.4.6. Con: [Hospitalization](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext#seccestitle130) required by severe forms of Covid-19 and seasonal influenza infections differ considerably.
1.2.5. Con: There are countries with very few or no Covid-19 related measures in place, and yet they have suffered few negative repercussions.
1.2.5.1. Pro: In the US state of Florida, since Oct 2020, it has not been mandatory to wear masks and adhere to social distancing. Additionally no vaccine was available at that time either. Yet the Covid-19 related case rates [are similar](https://www.newsweek.com/florida-sees-same-covid-case-rate-california-despite-no-statewide-restrictions-1576211) or fewer than in other states like California which have measures in place.
1.2.5.2. Pro: Sweden didn't have drastic measures in place in 2020 and the health system [did not become overwhelmed](https://odysee.com/\@YoutubeZensiert:8/IMG_20210328_150059_589:9) with patients.
1.2.5.2.1. Con: In December 2020, Stockholm [requested extra help](https://www.businessinsider.com/sweden-coronavirus-surge-alarm-stockholm-hospitals-herd-immunity-strategy-2020-12) from the government as its hospitals filled up with Covid-19 patients, and cases and deaths increased.
1.2.5.2.1.1. Pro: The mortality rate of Covid-19 [has been higher](https://www.bbc.com/news/world-europe-52903717) in Sweden than in any of its neighbours.
1.2.5.2.2. Pro: Through careful planning, Sweden was able [to double](https://www.thelocal.com/20200623/how-sweden-doubled-intensive-care-capacity-to-treat-coronavirus-patients/) its intensive care capacity during the Covid-19 pandemic.
1.2.5.2.3. Con: There were [nationwide staff shortages](https://www.bloombergquint.com/onweb/sweden-s-hospitals-now-face-nationwide-staff-shortages-sr) in Sweden, forcing hospitals [to halt](https://www.theguardian.com/world/2020/dec/17/king-sweden-failed-covid-strategy-rare-royal-rebuke-lockdown-hospitals-cases) all non-essential healthcare services.
1.2.5.2.3.1. Pro: An alarming number of healthcare workers in Sweden [resigned](https://www.bloombergquint.com/onweb/swedish-covid-workers-are-quitting-leaving-icus-short-staffed) due to the intense pressure and exhaustion caused by the Covid-19 pandemic.
1.2.5.2.4. Pro: Even though Sweden didn't have any drastic Covid-19 measures in place in 2020, the overall death rate [was comparable](https://odysee.com/\@YoutubeZensiert:8/IMG_20210328_150059_589:9) with that of England which had hard lockdowns and other safety measures such as mandatory face masks, etc.
1.2.5.2.4.1. Con: The [death rate](https://www.theguardian.com/world/2021/apr/13/sweden-has-highest-new-covid-cases-per-person-in-europe) in Sweden seems to be lower due to many of the most vulnerable individuals, such as care home residents, being vaccinated.
1.2.5.2.4.2. Con: The UK had an [extremely high death toll](https://theconversation.com/why-has-the-uks-covid-death-toll-been-so-high-inequality-may-have-played-a-role-156331#:~:text=Of%20all%20the%20countries%20with,the%20start%20of%20the%20year.)(Of all the countries with more than 12 million people, the UK had the highest crude pandemic mortality rate by the start of March 2021: 18 people had died of the disease for every 10,000 alive at the start of the year.) due to its failure to lockdown [quickly](https://www.theguardian.com/commentisfree/2020/apr/15/uk-government-coronavirus-science-who-advice) and [effectively](https://www.independent.co.uk/life-style/health-and-families/covid-uk-lockdown-reduce-spread-b1797534.html).
1.2.5.3. Con: The countries that have [best responded](https://www.movehub.com/blog/best-and-worst-covid-responses/) to the pandemic are those that instituted quick and effective measures.
1.2.5.3.1. Pro: Taiwan's [proactive approach](https://blogs.bmj.com/bmj/2020/07/21/what-we-can-learn-from-taiwans-response-to-the-covid-19-epidemic/) involved contact-tracing, testing, quarantine-treatment, alongside effective social care.
1.2.5.3.2. Pro: New Zealand owes its success in tackling the pandemic to [measures such as](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667\(20\)30225-5/fulltext) border restrictions and national lockdowns.
1.2.5.3.3. Pro: Singapore enacted [strict policies](https://journals.sagepub.com/doi/full/10.1177/0275074020942454) regarding mask-wearing, social distancing, and lockdowns in response to the Covid-19 pandemic.
1.2.5.4. Pro: Many African countries have few Covid-19 measures in place and have even [rejected](https://www.devex.com/news/the-countries-that-don-t-want-the-covid-19-vaccine-99243) vaccines, but there have not been reports of overflowing hospitals or excessive deaths.
1.2.5.4.1. Con: The president of Tanzania, one of the most outspoken skeptics of the virus, died in March 2021 from what many [suspect](https://www.bbc.com/news/world-africa-56437852) was a Covid-19 infection.
1.2.5.4.2. Con: This is most likely due to [under reporting](https://www.nytimes.com/2021/01/02/world/africa/africa-coronavirus-deaths-underreporting.html)(Stéphane Helleringer, a demographer who has worked on mortality in several African countries, said that on the African continent, “There are very, very few countries that even attempt an estimation of mortality based on death records.”), rather than an accurate assessment of the facts.
1.2.5.4.3. Con: It is likely that many countries in [Africa](https://theprint.in/world/an-india-like-deadly-covid-wave-will-have-worse-consequences-in-africa-top-health-body-warns/648703/) will see waves of Covid-19 infections and resulting deaths in the future.
1.2.5.5. Con: Even if Covid-19 death rate varies depending on different levels of medical preparedness, it does not entail that it is less dangerous than the flu.
1.2.5.6. Con: [India](https://www.bbc.co.uk/news/world-asia-india-56913047) did not prepare its health system for the second wave and, as a result, saw a huge increase in death rate.
1.2.6. Pro: A study in [March 2021](https://www.nature.com/articles/s41598-021-85081-0) showed that patients with Covid-19 are significantly less often treated as outpatients than patients with influenza.
1.2.7. Con: [Hospitalization](https://www.bmj.com/content/372/bmj.n506) among Covid-19 patients is likely to fall significantly after vaccination.
1.2.7.1. Pro: A [study](https://www.bmj.com/content/bmj/372/bmj.n612.full.pdf) in March 2021 showed that a single dose of Pfizer and Oxford vaccines reduced the risk of hospital admission by 80% in over 80s.
1.2.7.2. Con: Even if vaccinations reduce hospitalization, a huge portion of the world population is currently not [vaccinated](https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/), and therefore Covid-19 infections continue to have high hospitalization rates.
1.2.7.3. Pro: A [study](https://www.washingtonpost.com/health/2021/04/28/pfizer-moderna-vaccines-effective-protecting-seniors/) showed that elderly patients who are fully vaccinated are 94% less likely to be hospitalized with Covid-19.
1.2.7.4. Con: -> See 1.1.2.2.3.
1.2.8. Pro: Covid-19 infections have a higher risk of complications that require hospitalization arising.
1.2.8.1. Pro: Covid-19 patients have a higher risk of [respiratory complications](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext) that require hospitalization than flu patients.
1.2.8.1.1. Pro: The risk of pneumonia among Covid-19 patients is [twice that of flu patients](https://www.bmj.com/content/371/bmj.m4106).
1.2.8.1.2. Pro: Covid-19 patients have [1.7 times](https://www.bmj.com/content/371/bmj.m4106) more risk of respiratory failure than flu patients.
1.2.8.1.2.1. Pro: Covid-19 infections appear to have a higher potential for respiratory [pathogenicity](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext#seccestitle130).
1.2.8.2. Pro: [Haemorrhagic strokes](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext#seccestitle130) are more common among patients with Covid-19 compared to patients with the flu.
1.2.8.2.1. Pro: Haemorrhagic strokes require [immediate and long-term](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2823144/) clinical care.
1.2.8.2.2. Pro: After suffering from a stroke, a patient will need to stay in the hospital for the next [five to seven days.](https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/stroke-recovery-timeline#:~:text=The%20typical%20length%20of%20a,will%20determine%20the%20rehabilitation%20plan.)(The typical length of a hospital stay after a stroke is five to seven days. During this time, the stroke care team will evaluate the effects of the stroke, which will determine the rehabilitation plan.)
1.3. Con: Covid-19 and the flu spread in similar ways.
1.3.1. Con: The speed of [transmission](https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2) of Covid-19 and the flu is different.
1.3.1.1. Pro: -> See 1.2.1.
1.3.2. Pro: The same measures are required to contain the spread of both viruses.
1.3.2.1. Pro: [Social distancing](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777863) helps reduce both Covid-19 and flu infections.
1.3.2.2. Pro: The spread of both, Covid-19 and the flu, can be prevented by [mask-wearing](https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-face-masks-what-you-need-to-know).
1.3.2.3. Pro: There have been [decreases in influenza infections](https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=32941415&dopt=Abstract) in 2020 due to interventions such as limiting international travel.
1.3.3. Pro: Covid-19 and influenza have shared [social](https://publichealth.jmir.org/2021/3/e24696) determinants of transmission.
1.3.3.1. Pro: -> See 1.3.2.1.
1.3.3.2. Pro: There is evidence of higher infection and mortality among [racially disadvantaged communities](https://publichealth.jmir.org/2021/3/e24696) in the case of both Covid-19 and influenza.
1.3.3.2.1. Pro: In the US, Covid-19 incidence and mortality is higher among [African American](https://linkinghub.elsevier.com/retrieve/pii/S1047-2797\(20\)30176-9) communities.
1.3.3.2.2. Pro: During the [2009 H1N1 influenza pandemic](http://europepmc.org/abstract/MED/21164098) in the US, people from African American communities saw higher rates of infection and morbidity.
1.3.4. Con: The transmissibility of a disease alone is not an accurate measure of how dangerous the disease is. Factors such as the vulnerability of the population, and the capacity of a country to fight the disease must also be considered.
1.3.4.1. Pro: Based on the [Pandemic Severity Assessment Framework](https://en.wikipedia.org/wiki/Pandemic_Severity_Assessment_Framework), [researchers rate Covid-19 as a 5 on transmissibility, and a 5-7 on clinical severity, categorising it in the 'Very High Severity' category](https://www.researchgate.net/publication/340389292_Assessing_the_severity_of_COVID-19) \(the highest available on this framework\). By contrast, seasonal influenza generally sits in the 'Low Severity' or 'Moderate Severity' bands, occasionally rising to 'High Severity' at its worst.
1.3.5. Pro: Covid-19 and the flu spread through similar conduits.
1.3.5.1. Pro: Both Covid-19 and the flu can spread when people [touch a surface](https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu) with viruses on it.
1.3.5.1.1. Pro: Covid-19 can persist on surfaces for [hours to days](https://www.webmd.com/lung/how-long-covid-19-lives-on-surfaces), similar to the time-frame that the influenza virus [persists for](https://www.health.com/condition/cold-flu-sinus/flu-virus-live-on-surfaces).
1.3.5.1.1.1. Con: These results are often produced in [laboratory settings](https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html)(However, experimental conditions on both porous and non-porous surfaces do not necessarily reflect real-world conditions, such as initial virus amount \(e.g., viral load in respiratory droplets\) and factors that can remove or degrade the virus, such as ventilation and changing environmental conditions) that do not replicate real world situations.
1.3.5.1.1.1.1. Pro: One study [found](https://www.nature.com/articles/d41586-021-00251-4)(On the basis of the levels of RNA contamination and how often people touched surfaces such as doorknobs and buttons at pedestrian crossings, the team estimated that the risk of infection from touching a contaminated surface is less than 5 in 10,000 — lower than estimates for SARS-CoV-2 infection through aerosols, and lower than surface-transmission risk for influenza or norovirus.) that the risk of surface transmission for Covid-19 is lower than that of influenza.
1.3.5.1.2. Con: Multiple [studies](https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html)(People can be infected with SARS-CoV-2 through contact with surfaces. However, based on available epidemiological data and studies of environmental transmission factors, surface transmission is not the main route by which SARS-CoV-2 spreads, and the risk is considered to be low.) have found that surface transmission is uncommon for Covid-19.
1.3.5.1.2.1. Pro: Some scientists have [warned](https://www.nature.com/articles/d41586-021-00251-4)(“It’s become clear that transmission by inhalation of aerosols — the microscopic droplets — is an important if not dominant mode of transmission,” says Marr, who studies airborne disease transmission. Excessive attention on making surfaces pristine takes up limited time and resources that would be better spent on ventilation or the decontamination of the air that people breathe, she says.) that excessive attention to disinfecting surfaces draws resources away from improving ventilation and other measures that more effectively curtail the virus' spread.
1.3.5.2. Pro: Both the flu and Covid-19 spread via [droplets](https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu) or smaller virus particles.
1.3.5.2.1. Pro: Covid-19 and flu [viral particles](https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu) can linger in the air and infect a person that inhales them.
1.3.5.3. Con: Transmission from [children to adults](https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2) is common with the flu, but not with Covid-19 \(p. 2\).
1.3.5.3.1. Pro: Studies have found that children are [much less likely](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469891/) to contract and spread Covid-19.
1.3.5.3.2. Pro: According to a [collection of international family clusters](https://adc.bmj.com/content/105/7/618.long)(A collection of international family clusters found that children were not likely to be the index case in households, only being responsible for around 10% of clusters.9 Data from Guangzhou have supported this, finding an even lower rate of children as index cases in households at 5%.), children were only responsible for 10% of household clusters.
1.3.5.4. Pro: [Animals](https://www.sciencedirect.com/science/article/pii/S0882401020309207?casa_token=ymG_Qfr-pBgAAAAA:azdmcaKMiAvgpadCq7mlU1e5Du4Jkq07YvI0GwuPkcl3qEyEPJAGwrDeBVIEbVwZciuMI50OLg) can act as reservoirs of both the influenza virus and Covid-19.
1.3.5.4.1. Pro: Humans, avian, and swine are three important hosts for the [influenza](https://www.who.int/news-room/fact-sheets/detail/influenza-\(avian-and-other-zoonotic\)) virus.
1.3.5.4.2. Pro: [Bats](https://www.sciencedirect.com/science/article/pii/S0882401020309207?casa_token=ymG_Qfr-pBgAAAAA:azdmcaKMiAvgpadCq7mlU1e5Du4Jkq07YvI0GwuPkcl3qEyEPJAGwrDeBVIEbVwZciuMI50OLg) are considered to be the probable source of Covid-19 virus.
1.3.6. Pro: The time and conditions that are most conducive for the transmission of the virus are similar for both Covid-19 and influenza.
1.3.6.1. Pro: A study found that both Covid-19 and the flu [can be transmitted](https://academic.oup.com/cid/article/64/6/736/2733100) by paucisymptomatic patients, albeit at a reduced rate.
1.3.6.1.1. Con: Asymptomatic Covid-19 patients are [42% less likely](https://www.nature.com/articles/d41586-020-03141-3) to transmit the virus than symptomatic patients. In comparison, asymptomatic flu patients [rarely spread](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646474/#:~:text=Although%20asymptomatic%20individuals%20may%20shed,viral%20shedding%20and%20disease%20transmission.) the influenza virus.
1.3.6.2. Pro: Both [Covid-19](https://www.yalemedicine.org/conditions/covid-19/) and the [flu](https://www.cdc.gov/flu/about/disease/spread.htm) are most contagious when people are symptomatic.
1.3.6.2.1. Con: Covid-19 is [significantly more contagious](https://www.businessinsider.com.au/coronavirus-contagious-r-naught-average-patient-spread-2020-3?r=US&IR=T) even if it is only contagious only when people are symptomatic.
1.3.6.2.1.1. Pro: The new coronavirus has an R0 of roughly 2 to 2.5, meaning that each new person spreads the disease to [about 2.2 people](https://www.businessinsider.com.au/coronavirus-contagious-r-naught-average-patient-spread-2020-3?r=US&IR=T) on average. That makes Covid-19 more contagious than the seasonal flu \([R0 of about 1.3](https://www.theatlantic.com/science/archive/2020/01/how-fast-and-far-will-new-coronavirus-spread/605632/)\).
1.3.6.2.2. Con: While Covid-19 is most contagious while someone has symptoms, it's significantly contagious [1-3 days prior](https://www.nytimes.com/2020/03/31/health/coronavirus-asymptomatic-transmission.html) to someone developing symptoms.
1.3.6.3. Pro: The spread of both Covid-19 and influenza show similar patterns of [seasonality](https://publichealth.jmir.org/2021/3/e24696).
1.3.6.3.1. Pro: In areas with more pronounced influenza seasonality, [Covid-19 epidemics](https://publichealth.jmir.org/2021/3/e24696) have followed trends similar to those seen for the flu.
1.3.6.3.2. Con: In some regions, [Covid-19](https://publichealth.jmir.org/2021/3/e24696) has seen resurgence outside of the traditional influenza season.
1.3.6.3.2.1. Pro: The US saw its second wave [peak](https://www.worldometers.info/coronavirus/country/us/#graph-cases-daily) in July 2020, which is outside the traditional influenza season.
1.3.6.4. Con: Such commonalities are to be expected, given that both Covid-19 and influenza are caused by viruses that tend to [thrive and transmit in](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148619/) similarly specific conditions.
1.4. Pro: As of March 2021, there were fewer [treatment](https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu) options available for Covid-19 infections than for flu infections.
1.4.1. Con: Coronaviruses are not new and have been around for a long time. Hence it is possible to estimate their risks and develop treatment plans to minimize their impact.
1.4.1.1. Con: The [potential risk](https://www.healthline.com/health/coronavirus-types#types) can vary greatly within a group of viruses.
1.4.1.1.1. Con: That the risk varies does not imply that rough estimates are not possible. Flu symptoms are caused by a number of different [mutating viruses](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928832/) - nevertheless, the risk of the flu is estimated on a yearly basis.
1.4.1.1.2. Pro: Some other members of the family of coronaviruses - [229E, NL63, OC43, and HKU1](https://www.cdc.gov/coronavirus/types.html) - cause unremarkable common colds. Yet other members are even more deadly than SARS-Cov-2, such as [MERS-CoV](https://www.cdc.gov/coronavirus/mers/index.html) and [Covid-19](https://www.cdc.gov/sars/index.html).
1.4.1.1.3. Pro: [Death rates](https://en.wikipedia.org/wiki/Coronavirus#Infection_in_humans) vary greatly among different coronaviruses.
1.4.1.1.3.1. Pro: SARS-CoV-2, SARS-CoV, and MERS-CoV have a mortality rate of [6.76%, 9.6%, and 35.5%](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334925/) respectively.
1.4.1.2. Pro: For decades, scientists have been aware of mutating coronaviruses that make people sick. They have developed [tools and monitoring systems](https://www.euromomo.eu/) that enable them to react effectively when viruses threaten the public health.
1.4.1.2.1. Con: Contact tracing [failed](https://www.nature.com/articles/d41586-020-03518-4)(In England, tracers fail to get in touch with one in eight people who test positive for COVID-19; 18% of those who are reached provide no details for close contacts. In some regions of the United States, more than half of people who test positive provide no details of contacts when asked.) in many developed countries during the pandemic.
1.4.1.2.2. Con: China's virus monitoring system detected Covid-19 in [Wuhan](https://www.newscientist.com/article/mg24532724-700-we-were-warned-so-why-couldnt-we-prevent-the-coronavirus-outbreak/). Yet, this was insufficient in stopping the global spread of the virus.
1.4.1.3. Pro: [Event 201](http://www.centerforhealthsecurity.org/event201/) from the World Economic Forum and a study from the [Robert Koch Institute](https://translate.google.com/translate?sl=auto&tl=en&u=https%3A%2F%2Fwww.alpenmag.de%2Fcoronapandemie-robert-koch-institut-hat-bundesregierung-bereits-2012-gewarnt-gutachten-beschreibt-szenario-im-detail%2F) simulated similar scenarios and predicted that an event like the Covid-19 pandemic would occur in the near future.
1.4.1.3.1. Con: These warnings failed to prepare the world for the Covid-19 pandemic, as many countries were ill-equipped to combat the disease when it emerged.
1.4.1.3.1.1. Pro: The US [did not replenish](https://www.pbs.org/wgbh/frontline/article/depleted-national-stockpile-contributed-to-covid-ppe-shortage/)(But after H1N1 subsided, neither Congress, the Obama White House, nor the subsequent Trump administration moved to substantially refill the stockpile — leaving a depleted stash of the N95 masks that would prove essential in protecting health care workers in the fight against COVID.) its stockpile of N95 masks after the H1N1 pandemic, resulting in a shortage that hurt healthcare workers early in the Covid-19 pandemic.
1.4.1.3.1.2. Pro: The UK government had a [confused and contradictory response](https://www.theguardian.com/world/ng-interactive/2020/dec/16/covid-chaos-a-timeline-of-the-uks-handling-of-the-coronavirus-crisis) to the pandemic, resulting in a surge of cases and deaths.
1.4.1.4. Pro: Before Covid-19, scientists were concerned about the outbreak of an [airborne zoonotic virus](https://www.contagionlive.com/news/zoonotic-threats-as-unpredictable-as-they-are-dangerous). That means they were able to assess its potential risks.
1.4.1.4.1. Con: After the threat posed by SARS was contained, many investors [stopped funding](https://www.nbcnews.com/health/health-care/scientists-were-close-coronavirus-vaccine-years-ago-then-money-dried-n1150091) research into coronaviruses. Due to the lack of funds, it was difficult for scientists to analyze the possible risks associated with them.
1.4.1.4.2. Con: Even with strong monitoring systems, it is not always possible to estimate the severity of infections caused by an unknown [coronavirus](https://www.newscientist.com/article/mg24532724-700-we-were-warned-so-why-couldnt-we-prevent-the-coronavirus-outbreak/).
1.4.1.5. Con: Even if experts possess this knowledge, if ordinary people do not understand or trust scientific data, it is unlikely that the recommended measures will be adhered to and the spread of the disease limited.
1.4.1.5.1. Pro: -> See 1.1.2.4.1.
1.4.1.5.2. Pro: Ignorance and mistrust of science can have negative societal implications.
1.4.1.5.2.1. Pro: One survey [found](https://ccp.jhu.edu/2019/04/24/trust-mistrust-ebola-spread-drc/) that one in four people in eastern Congo don't believe that Ebola is real, hindering efforts to combat the disease during outbreaks.
1.4.1.5.2.2. Pro: Protests against Covid-19 health guidelines have been linked to [extremist](https://globalnews.ca/news/7512876/extremists-anti-mask-demonstrations-canada/) [movements](https://www.huffpost.com/entry/anti-mask-protests-spain-europe_n_5f3ba1afc5b6e054c3feab32) that express wider distrust of governments and institutions.
1.4.1.5.3. Con: After procuring the relevant knowledge, public health officials can make this information more digestible so that the public can access and understand it.
1.4.1.5.3.1. Pro: At the onset of the Covid-19 pandemic, many [simple infographics](https://www.easel.ly/blog/coronavirus-infographics-templates-and-resources/) were made to help the public understand the importance of simple social distancing measures.
1.4.1.5.3.2. Pro: To help people understand the proper way and the importance of washing one's hands, many [child-friendly videos](https://www.savethechildren.net/news/new-child-friendly-handwashing-video-launched-communities-forgotten-covid-19-crisis) were made.
1.4.1.5.4. Con: Measures can be taken to combat misinformation.
1.4.1.5.4.1. Pro: A [coalition](https://en.unesco.org/news/unesco-part-alliance-combat-misinformation-covid-19-africa) comprising of members such as WHO and UNESCO has been formed to fight misinformation regarding Covid-19.
1.4.1.5.4.2. Pro: [Social media](https://link.springer.com/article/10.1007/s11077-020-09405-z) can be used to fight misinformation.
1.4.1.5.4.3. Con: It is significantly more challenging to combat [misinformation](https://www.imperial.ac.uk/stories/coronavirus-misinformation/) about a new disease like Covid-19 than about existing diseases like the flu.
1.4.1.5.5. Pro: The misinformation that [Covid-19](https://www.voanews.com/covid-19-pandemic/infodemic/infodemic-covid-19-isnt-normal-flu-virus) is no more dangerous than the flu is likely to undermine measures that curb the spread of infections.
1.4.1.6. Con: [Covid-19](https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus) is a relatively new member of the family of coronaviruses. Its risks cannot be estimated effectively.
1.4.1.6.1. Con: Viruses are constantly evolving. Sometimes new strains appear, some more virulent than others. That our measuring techniques and virology knowledge has evolved, does not necessarily imply that something surprising is happening now.
1.4.1.6.2. Con: -> See 1.4.1.3.
1.4.1.6.3. Pro: -> See 1.4.1.1.2.
1.4.1.6.4. Pro: [SARS](https://www.newscientist.com/article/mg24532724-700-we-were-warned-so-why-couldnt-we-prevent-the-coronavirus-outbreak/) had a genetic mutation that explained the extent of its spread in humans. Covid-19 does not have such a mutation and still spreads faster among humans than SARS.
1.4.1.7. Con: Among many potential coronaviruses that can infect humans, only [six species](https://en.wikipedia.org/wiki/Coronavirus#Infection_in_humans) of coronaviruses are known.
1.4.1.8. Con: Even if it is possible to minimize the impact of [new viruses](https://www.bbc.com/future/article/20210111-what-could-the-next-pandemic-be), some of them can still be more dangerous than the flu in terms of the rate of morbidity and mortality they can cause.
1.4.2. Con: As of 6th May 2020, 7 companies were [working](https://www.marketwatch.com/story/these-nine-companies-are-working-on-coronavirus-treatments-or-vaccines-heres-where-things-stand-2020-03-06) on developing a treatment for Covid-19.
1.4.3. Pro: The emergence of mutant strains of Covid-19 have [made it harder](https://www.vox.com/22298973/covid-19-vaccine-mutation-coronavirus-variant-moderna-pfizer-johnson) for treatments \(such as vaccines\) to keep up with the virus.
1.4.3.1. Pro: There are concerns that some vaccines might not be very effective against certain [new strains](https://www.nature.com/articles/d41586-020-00502-w) of the Covid-19 virus.
1.4.3.1.1. Con: Some pharmacutical companies are already responding to this scenario and [developing](https://www.cnbc.com/2021/03/31/us-begins-testing-modernas-covid-vaccine-booster-shots-for-variant-from-south-africa.html) booster shots that target the new variants.
1.4.3.1.2. Pro: The Pfizer vaccine had [reduced effectiveness](https://www.nejm.org/doi/full/10.1056/NEJMc2102017?query=featured_home) against Covid-19 variants, particularly the South African variant.
1.4.3.1.3. Pro: The efficacy of Johnson & Johnson dropped from [72 to 64%](https://www.nytimes.com/2021/02/24/health/covid-vaccine-johnson-and-johnson.html) when tested against the South African variant.
1.4.3.1.4. Pro: Novavax’s vaccine's efficacy dropped from [89% to 49%](https://www.nytimes.com/2021/01/28/health/covid-vaccine-novavax-south-africa.html) when tested against the South African variant.
1.4.3.1.5. Con: While less effective against the new variants, the vaccines will still provide [some degree of protection](https://www.who.int/news-room/feature-stories/detail/the-effects-of-virus-variants-on-covid-19-vaccines) against these strains of Covid-19.
1.4.3.1.5.1. Pro: The vaccines that are currently in use can [still protect](https://www.cnbc.com/2021/03/05/how-the-different-covid-vaccines-will-handle-variants.html) individuals, albeit in a reduced capacity, from the new Covid-19 variants.
1.4.3.2. Con: The [Covid-19 virus](https://www.livescience.com/coronavirus-mutation-rate.html) seems to mutate much slower than the seasonal flu virus.
1.4.3.2.1. Pro: It is estimated that Covid-19 accumulates an additional mutation [once every 11 days](https://science.sciencemag.org/content/371/6528/466). The influenza virus has a mutation rate of [2.0 × 10^−6 and 0.6 × 10^−6](https://jvi.asm.org/content/80/7/3675) mutations per site per infectious cycle, with one replication cycle [lasting 6 hours](https://www.euro.who.int/en/health-topics/communicable-diseases/influenza/data-and-statistics/virology-of-human-influenza).
1.4.3.2.2. Pro: Covid-19's lower mutation rate is the result of the presence of [basic proofreading machinery](https://pubmed.ncbi.nlm.nih.gov/33064680/) that helps prevent errors from being integrated.
1.4.3.3. Con: Once the basic groundwork for the vaccine has been established, it is possible to quickly and effectively [adapt the vaccine](https://www.pbs.org/newshour/health/covid-19-vaccines-can-adapt-to-new-variants-heres-what-it-will-take#:~:text=In%20the%20U.S.%2C%20the%20new,57.6%20percent%20—%20during%20clinical%20trials.) so that it is effective against the new variants.
1.4.3.3.1. Pro: -> See 1.4.3.1.1.
1.4.3.3.2. Pro: [Legislative provisions](https://ec.europa.eu/commission/presscorner/detail/en/ip_21_1088) are being made to accelerate the approval of adapted vaccines.
1.4.4. Pro: Unlike for Covid-19, there are [antiviral drugs](https://www.medicalnewstoday.com/articles/coronavirus-vs-flu#treatment) that help reduce illness caused by a flu infection.
1.4.4.1. Pro: Antiviral drugs reduce symptoms from flu infection by [1–2 days](https://www.cdc.gov/flu/treatment/index.html).
1.4.4.2. Con: In March 2021, [Pfizer](https://pharmaphorum.com/news/pfizer-begins-clinical-trials-of-covid-19-antiviral-pill/) began clinical development of an antiviral pill against Covid-19.
1.4.4.2.1. Pro: Pfizer's CEO [believes](https://www.cnbc.com/2021/04/27/pfizer-at-home-covid-pill-could-be-available-by-year-end-ceo-albert-bourla-says.html) that the pill could be available by the end of 2021.
1.4.4.3. Con: A [study](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777863) in March 2021 showed that the antiviral drug remdesivir was associated with faster clinical improvement in hospitalized Covid-19 patients.
1.4.4.3.1. Pro: Remdesivir was approved by the FDA in America in October 2020 and was [shown](https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-covid-19)(The median time to recovery from COVID-19 was 10 days for the Veklury \[remdsivir\] group compared to 15 days for the placebo group, a statistically significant difference.) to reduce hospital stays for Covid-19 patients by up to five days.
1.4.4.3.2. Con: In April 2021, there was a remdesivir [shortage](https://indianexpress.com/article/explained/from-glut-to-shortage-story-of-remdesivir-the-drug-of-hope-in-covid-surge-7272095/) in many countries as new waves of infection occured.
1.4.4.4. Pro: [Adamantanes and neuraminidase inhibitors](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404498/) are two approved drugs for controlling the flu.
1.4.5. Pro: Unlike for Covid-19, a vaccine for flu infections is [readily available](https://www.scientificamerican.com/article/how-are-seasonal-flu-vaccines-made/#:~:text=Each%20year%2C%20a%20new%20flu,to%20wreak%20havoc%20that%20season.) each year.
1.4.5.1. Pro: The flu vaccine has an effectiveness between [40-60%](https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm#:~:text=While%20vaccine%20effectiveness%20\(VE\)%20can,matched%20to%20the%20flu%20vaccine.).
1.4.5.2. Con: A [number of effective vaccines](https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines) have been developed against Covid-19.
1.4.5.2.1. Pro: AstraZeneca has an [effectiveness of 76%.](https://www.nature.com/articles/d41586-021-00836-z)
1.4.5.2.2. Pro: Pfizer has an effectiveness of [94-97%.](https://www.pfizer.com/news/press-release/press-release-detail/real-world-evidence-confirms-high-effectiveness-pfizer#:~:text=Vaccine%20effectiveness%20was%20at%20least%2097%25%20against%20symptomatic%20COVID-19,SARS-CoV-2%20infections.)
1.4.5.2.3. Con: -> See 1.4.3.1.
1.4.5.2.4. Pro: Sputnik V has an efficacy of [91.6%.](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(21\)00191-4/fulltext)
1.4.5.2.5. Pro: It is possible that the vaccine against [influenza](https://www.ajmc.com/view/flu-vaccine-may-protect-against-covid-19-infection) can provide protective effects against severe Covid‐19 infections.
1.4.5.2.6. Con: Pfizer's CEO has said he thinks it is likely that people will need [booster shots](https://www.nbcnews.com/science/science-news/covid-19-booster-shot-likely-needed-12-months-pfizers-ceo-says-rcna692) annually for the vaccines to remain effective. Therefore, the existing vaccines aren't effective at eliminating the disease longterm. The problem won't be solved with just one shot - it will need to be an ongoing process.
1.4.5.2.6.1. Con: A flu shot is needed [every season](https://www.cdc.gov/flu/prevent/keyfacts.htm#:~:text=Why%20do%20I%20need%20a,is%20needed%20for%20optimal%20protection.)(A flu vaccine is needed every season for two reasons. First, a person’s immune protection from vaccination declines over time, so an annual vaccine is needed for optimal protection. Second, because flu viruses are constantly changing, flu vaccines may be updated from one season to the next to protect against the viruses that research suggests may be most common during the upcoming flu season.) for one to be adequately protected from contracting the influenza virus.
1.4.5.2.7. Con: People are more likely to be [hesitant](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245907#sec011) towards getting vaccinated against Covid-19 than against influenza.
1.4.5.2.7.1. Pro: Studies have [found](https://www.nature.com/articles/s41591-021-01260-6) that the spreading of anti-vaccination propaganda is a multi-million dollar industry comprised of highly sophisticated misinformation strategies.
1.4.5.2.7.1.1. Pro: Countries like [France](https://www.bbc.com/news/blogs-trending-56526265)(Research from BBC Monitoring found that the number of followers of pages sharing extreme anti-vaccine content in French grew in 2020, from 3.2m to nearly 4.1m likes.) have been bombarded with anti-vaccination propaganda on social media.
1.4.5.2.7.1.2. Con: Anti-vaccination propaganda is likely to effect people's sentiments on getting vaccinated against the influenza virus as well.
1.4.5.2.7.2. Con: Approximately [50%](https://www.cnbc.com/2021/02/10/biden-covid-vaccine-anti-vaxxers-us.html)(just under half of adults in the U.S. surveyed in December said they were very likely to get vaccinated, according to a new study from the U.S. Centers for Disease Control and Prevention.) of US adults say they are "very likely" to get vaccinated for Covid-19. This is roughly equal to the [48.4%](https://www.cdc.gov/flu/fluvaxview/coverage-1920estimates.htm)(Overall, among adults ≥18 years, flu vaccination coverage was 48.4%, 3.1 percentage points higher than coverage during the 2018–19 season) of US adults who got the influenza vaccine in 2018-2019.
1.4.5.2.8. Con: There are more institutional measures mandating [vaccinations against influenza](https://jamanetwork.com/journals/jama/article-abstract/2774712)(\[A\]t least 16 states require influenza or hepatitis B vaccinations for postsecondary education.) than against Covid-19.
1.4.5.2.9. Pro: Once enough people are [vaccinated](https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/when-will-the-covid-19-pandemic-end), Covid-19 will no longer be more dangerous than the flu.
1.4.5.2.9.1. Pro: Following successful vaccinations, [monthly mortality](https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/when-will-the-covid-19-pandemic-end) from Covid-19 may start to resemble that of the flu in an average year.
1.4.5.2.9.2. Pro: [Death rates](https://www.politico.eu/article/coronavirus-deaths-statistics-data-cases-accuracy/) are likely to reduce dramatically after the vaccine is rolled out and administered.
1.4.5.2.9.2.1. Pro: Vaccination reduces the risk of severe infection among [people aged over 80s](https://www.bmj.com/content/bmj/372/bmj.n612.full.pdf), who are most at risk of mortality from Covid-19.
1.4.5.2.9.2.2. Pro: By March 2021, all the [vaccines](https://edition.cnn.com/2021/03/22/health/covid-vaccines-prevent-death/index.html) available were shown to reduce mortality from Covid-19 infections.
1.4.5.2.9.2.3. Con: It is unlikely that the world population will be vaccinated against Covid-19 before the end of [2022](https://www.nature.com/articles/d41586-021-00727-3).
1.4.5.2.9.2.4. Con: Even if vaccination reduces the mortality rate, a huge portion of the world population is currently not [vaccinated](https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/) and therefore Covid-19 infections continue to have high death rates.
1.4.5.2.9.2.4.1. Pro: By the end of April 2021, only around [7.2% of the world population](https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/) was vaccinated against Covid-19.
1.4.6. Con: Treatments for the [flu](https://www.webmd.com/cold-and-flu/flu-treatment) and Covid-19 both help manage the symptoms of the infection as opposed to treating the underlying cause.
1.4.7. Con: Early evidence suggests that [tocilizumab](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154566/) could be effective as a treatment for Covid-19 infection.
1.4.7.1. Con: As of February 2021, the use of tocilizumab is considered [experimental](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369580/), and in need of further trials to validate its purported efficacy.
1.4.7.2. Con: Tocilizumab is only recommended for people already suffering from [extreme effects](https://www.covid19treatmentguidelines.nih.gov/statement-on-tocilizumab/)(tocilizumab, when added to corticosteroid therapy, offers a modest mortality benefit in certain patients with COVID-19 who are severely ill and exhibit rapid clinical deterioration with increasing oxygen needs and a significant inflammatory response to the virus. However, the Panel found it challenging to define the specific population\(s\) that would benefit from this intervention.) of the disease, so it is not useful for the majority of the population.
1.5. Con: Covid-19 and the flu are the [same](https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu) symptomatically.
1.5.1. Con: Even though Covid-19 shares many of the same basic symptoms as the flu, these symptoms are relatively more [severe](https://www.sciencedirect.com/science/article/pii/S0882401020309207?casa_token=ymG_Qfr-pBgAAAAA:azdmcaKMiAvgpadCq7mlU1e5Du4Jkq07YvI0GwuPkcl3qEyEPJAGwrDeBVIEbVwZciuMI50OLg) in Covid-19.
1.5.1.1. Con: -> See 1.4.1.2.
1.5.2. Pro: Both Covid-19 and the flu involve fatigue, fever and sore throat as [symptoms](https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm).
1.5.2.1. Pro: [Fever](https://www.sciencedirect.com/science/article/pii/S0882401020309207?casa_token=ymG_Qfr-pBgAAAAA:azdmcaKMiAvgpadCq7mlU1e5Du4Jkq07YvI0GwuPkcl3qEyEPJAGwrDeBVIEbVwZciuMI50OLg) is caused due to an increase in inflammatory cytokine levels brought on by anti-viral innate immune responses in both influenza and Covid-19 infections.
1.5.2.2. Con: [Sore throat](https://www.emersonhospital.org/articles/allergies-or-covid-19) is a more prominent symptom in flu than in Covid-19 infections.
1.5.3. Con: A person infected with [Covid-19](https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm) can take longer to develop symptoms than they would if they had the flu.
1.5.3.1. Pro: [Flu symptoms](https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm) appear 1 to 4 days after infection whereas Covid-19 symptoms usually appear 5 days after infection.
1.5.4. Pro: Muscle pain and body aches [are symptoms](https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm) of both Covid-19 and flu infections.
1.5.5. Pro: [Covid-19 and influenza viruses](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607235/) use almost identical strategies to escape the host's antiviral responses.
1.5.6. Pro: Both influenza and Covid-19 similarly impact patients with [inflammatory bowel disease](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935616/).
1.5.7. Con: It is possible to [diagnostically](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(20\)30255-8/fulltext) differentiate between Covid-19 and influenza infections. This shows that there are differences in how symptoms manifest in these two infections.
1.5.7.1. Con: Some cases of [co-infection](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607235/)(from section 6.3) with both Covid-19 and influenza viruses have made diagnosis challenging.
1.5.7.1.1. Pro: Radiographic analysis showed no significant difference between patients with [Covid-19 and co-infected](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228290/) patients.
1.5.7.1.2. Pro: As of March 2021, we are able to diagnose flu with more specificity than [Covid-19](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607235/).
1.5.7.2. Pro: [Bilateral GGOs and consolidations](https://www.tandfonline.com/doi/full/10.1080/23744235.2020.1840623), observed through chest X-rays, can help to differentiate Covid-19 from influenza.
1.5.7.3. Pro: Covid-19 patients show a [higher level of lactate dehydrogenase](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(20\)30255-8/fulltext) \(LDH\) than patients with influenza.
1.5.7.4. Pro: Unlike in the flu, the most commonly reported [laboratory abnormalities](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(20\)30255-8/fulltext) in Covid-19 include lymphopenia and prolonged prothrombin time \(PT\).
1.5.7.5. Con: There are concerns that diagnosis will become difficult when the Covid-19 pandemic [overlaps](https://doi.org/10.1126/science.abd2220) with influenza epidemics.
1.5.7.6. Pro: There are significant differences in [laboratory parameters](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(20\)30255-8/fulltext#bib0005) between hospitalized Covid-19 and influenza patients.
1.5.8. Con: Data comparing patients with [Covid-19 infection](https://www.nature.com/articles/s41598-021-85081-0) to patients with influenza in the hospital setting is limited.
1.5.9. Pro: The groups at risk for complications from [H1N1 influenza and Covid-19](https://www.healthline.com/health/h1n1-vs-covid-19#similarities) have significant overlap.
1.5.9.1. Con: It appears that [children](https://www.ncbi.nlm.nih.gov/pubmed/32392591) are more likely to develop severe symptoms when infected with the flu than with Covid-19.
1.5.9.1.1. Pro: Children [under the age of 5](https://www.healthline.com/health/h1n1-vs-covid-19#similarities) were at risk for serious illness from H1N1 influenza virus but not from Covid-19.
1.5.9.2. Pro: The overall incidence and severity of both Covid-19 and influenza is higher among [male patients](https://www.nature.com/articles/s41598-021-85081-0) than among female patients.
1.5.9.2.1. Con: Mortality rates between genders are inconsistent around the world.
1.5.9.2.1.1. Pro: While men have a higher mortality rate overall, [women](https://www.thelancet.com/journals/langlo/article/PIIS2214-109X\(20\)30464-2/fulltext)(In India, the COVID-19 case fatality rate among men is 2·9% and 3·3% among women.3\nCase fatality rates in Nepal, Vietnam, and Slovenia are also higher among women than men.) in countries such as India, Nepal, Vietnam, and Slovenia are more likely to die of Covid-19.
1.5.10. Con: There are many symptoms unique to Covid-19 infections.
1.5.10.1. Pro: Covid-19 can cause damage to [organ systems, such as the heart and kidneys](https://www.washingtonpost.com/health/coronavirus-destroys-lungs-but-doctors-are-finding-its-damage-in-kidneys-hearts-and-elsewhere/2020/04/14/7ff71ee0-7db1-11ea-a3ee-13e1ae0a3571_story.html), and there has been a significant link between [Covid-19 and strokes](https://www.vox.com/2020/5/1/21244171/stroke-coronavirus-symptoms-blood-clots). The regular flu does not show these symptoms.
1.5.10.1.1. Pro: A [study](https://www.bmj.com/content/371/bmj.m4677) in December 2020 showed that, compared with the flu, Covid-19 was associated with an increased risk of extra-pulmonary organ dysfunction and death.
1.5.10.1.2. Con: Both infections can lead to [multi-organ failures](https://www.sciencedirect.com/science/article/pii/S0882401020309207?casa_token=ymG_Qfr-pBgAAAAA:azdmcaKMiAvgpadCq7mlU1e5Du4Jkq07YvI0GwuPkcl3qEyEPJAGwrDeBVIEbVwZciuMI50OLg).
1.5.10.2. Pro: Unlike the flu, symptoms of Covid-19 include a [loss of smell and taste](https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm).
1.5.10.3. Pro: Unlike the flu, Covid-19 can cause [shortness of breath](https://www.healthline.com/health/coronavirus-shortness-of-breath) and chronic lung problems.
1.5.10.3.1. Con: Covid-19 shares many clinical symptoms with [pneumonia](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(20\)30255-8/fulltext#bib0004), which is caused by the influenza virus.
1.5.10.4. Pro: [Non-productive dry cough](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607235/)(Table 1) is a symptom seen in Covid-19 infections but not in flu infections.
1.5.10.5. Pro: Unlike with the flu, skin rash and [discolouration of toes](https://www.aad.org/public/diseases/coronavirus/covid-toes) or fingers are symptoms of Covid-19 infection.
1.6. Con: -> See 1.2.5.
1.7. Pro: Compared to the flu, the death rate for Covid-19 patients is very high.
1.7.1. Pro: The total number of deaths caused by Covid-19 is [well above the number of deaths](https://www.who.int/influenza/surveillance_monitoring/updates/latest_update_GIP_surveillance/en/) caused by the influenza virus.
1.7.1.1. Pro: An analysis in [March 2021](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext#seccestitle130) showed excess mortality associated with Covid-19 relative to the flu.
1.7.1.1.1. Pro: Excess mortality associated with [Covid-19](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext#seccestitle130) relative to flu, with an age-standardised mortality, is equivalent to 2:8.
1.7.1.2. Pro: [346,000 people](https://news.google.com/covid19/map?hl=en-US&mid=%2Fm%2F09c7w0&gl=US&ceid=US%3Aen) died in the US due to Covid-19 in 2020. In comparison, the 2019-2020 flu season caused [22,000 deaths](https://www.prevention.com/health/a34671428/how-many-people-die-from-flu/) in the US.
1.7.1.3. Pro: The [mortality rate](https://www.goodrx.com/blog/flu-vs-coronavirus-mortality-and-death-rates-by-year/) for Covid-19 is 3.1%, while the fatality rate for the influenza virus is typically estimated to be 0.1%
1.7.1.4. Con: Excess deaths caused by Covid-19 are comparable to those caused by influenza during the severe phases of influenza epidemics.
1.7.1.4.1. Pro: A study in [2021](https://pubmed.ncbi.nlm.nih.gov/33395381/) estimated that, in the Netherlands, the number of excess deaths during Covid-19 epidemic weeks in 2020 were comparable to the excess deaths during the severe influenza epidemic of 2017-18.
1.7.1.4.2. Con: Severe influenza epidemics are outliers and therefore mortality rates from such phases are not indicative of the usual mortality associated with influenza.
1.7.1.4.3. Con: The 2018–19 seasonal [influenza](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext#seccestitle130) is not representative of all seasonal influenzas.
1.7.2. Pro: The [death rate](https://ourworldindata.org/mortality-risk-covid#case-fatality-rate-of-covid-19-by-age) for Covid-19 among those aged 60+ is [comparable](https://en.wikipedia.org/wiki/List_of_human_disease_case_fatality_rates) to more serious diseases like SARS and typhoid.
1.7.2.1. Con: By contrast, death rates for children and teenagers with Covid-19 are [hundreds or thousands of times lower](https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html) than for the elderly.
1.7.2.1.1. Con: [In-hospital mortality](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext)(In children, although the rate of hospitalisation for COVID-19 appears to be lower than for influenza, in-hospital mortality is higher) is higher among younger patients with Covid-19 than among younger patients with influenza, even though children with Covid-19 are at a lower risk of hospitalisation for Covid-19.
1.7.3. Con: [Higher mortality of Covid-19](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext)("Another potential explanation for the higher mortality of COVID-19 is that the sudden influx of patients over a short period of time created medical structural constraints, and care teams were led to prioritise patients based on clinical status and prognosis. This hypothesis is supported by the lower rate of transfer to ICU in patients older than 80 years with COVID-19, which strongly contrasts with the higher mortality in these same patients."\n\nFrom Discussion, paragraph 4.) could be due to medical constraints created by the sudden influx of patients over a short period of time.
1.7.3.1. Pro: -> See 1.2.3.
1.7.3.2. Con: [Higher mortality rate](https://www.nature.com/articles/s41598-021-85081-0) among Covid-19 patients is seen even among those hospitalized in well-equipped units.
1.7.3.3. Con: Even within the same medical constraints, peaks in flu infections do not result in higher mortality in the same way as peaks in [Covid-19 infections](https://www.healthline.com/health-news/why-covid-19-isnt-the-flu) do.
1.7.4. Con: Millions more people [recover](https://www.worldometers.info/coronavirus/) from Covid-19 than die from it.
1.7.4.1. Con: Having more people recover from a disease than die from it is not an indication of its severity.
1.7.4.1.1. Pro: Ebola, one of the most serious known diseases, has a death rate of around [50%](https://www.afro.who.int/health-topics/ebola-virus-disease)(The average EVD case fatality rate is around 50%.).
1.7.4.1.2. Pro: If the [transmission](https://www.bmj.com/content/372/bmj.n579) rate of an infection is high, even if the recovery rate is high, the small proportion of people that do die from Covid-19 will be high in absolute numbers.
1.7.4.2. Con: Even if Covid-19 infection is mild for most people, when absolute numbers are considered, it is quite [severe](https://weillcornell.org/news/covid-19-why-is-it-mild-for-some-deadly-for-others) for many.
1.7.5. Con: The death rate for [Covid-19](https://www.livescience.com/new-coronavirus-compare-with-flu.html) is not globally consistent.
1.7.5.1. Pro: Countries like South Korea don't have a high death rate, despite having had a high infection rate [early](https://www.bbc.com/news/world-asia-51596665) in the pandemic.
1.7.5.1.1. Con: As treatment of serious cases progressed, South Korea's fatality rate rose. In May 2020, it was at a peak of [2.39%](https://ourworldindata.org/mortality-risk-covid?country=~KOR#the-case-fatality-rate). This is because it takes a significant amount of time post-infection for the average Covid-19 fatality rate to actually rise.
1.7.5.1.2. Con: Even given the lower death rates in South Korea, Covid-19 is still a far more dangerous disease than the flu.
1.7.5.1.2.1. Pro: The overall death rate in the US from 2019's flu season was about [0.1%](https://www.businessinsider.com/coronavirus-death-rate-south-korea-compared-to-flu-2020-3), nearly 8.5 times lower than South Korea's Covid-19 death rate.
1.7.5.1.2.1.1. Pro: While both the flu and Covid-19 are more dangerous for older patients than younger patients, the flu's death rate of about [0.8%](https://www.businessinsider.com/coronavirus-death-rate-south-korea-compared-to-flu-2020-3) among patients 65 and older is about one-fourth that of South Korea's Covid-19 death rate of about 3.4% among patients 60 and older at the beginning of the pandemic.
1.7.5.2. Con: A lack of consistency between countries does not diminish the severity of the virus overall.
1.7.5.2.1. Pro: Variation in death rates are likely due to a [variety of factors](https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-00786-0), such as the quality of health care and the average age of the population.
1.7.5.2.1.1. Pro: One study found that long term exposure to [air pollution](https://www.escardio.org/The-ESC/Press-Office/Press-releases/study-estimates-exposure-to-air-pollution-increases-covid-19-deaths-by-15-world)(The study, published in Cardiovascular Research \[1\] today \(Tuesday\), estimated that about 15% of deaths worldwide from COVID-19 could be attributed to long-term exposure to air pollution. In Europe the proportion was about 19%, in North America it was 17%, and in East Asia about 27%.) contributed to 15% of Covid-19 deaths worldwide and varied between regions.
1.7.5.2.2. Pro: [Countries](https://www.movehub.com/blog/best-and-worst-covid-responses/) that responded with strong testing, tracing and isolating measures were able to reduce their death rates. However, such large scale measures entail that Covid-19 infection was severe.
1.7.5.3. Pro: In Italy, more people died from Covid-19 infections during the first wave of the pandemic than from the flu.
1.7.5.3.1. Pro: The death toll from an outbreak of Covid-19 in Italy rose in by 427 to [3,405](https://www.aljazeera.com/news/2020/03/uk-schools-close-italy-covid-19-deaths-jump-live-updates-200318235116951.html) in a single day. In comparison, between 2013 and 2017, influenza has killed, on average, approximately [38](https://www.2oceansvibe.com/2020/03/11/how-many-people-die-annually-from-flu-in-italy/) people per day.
1.7.5.3.1.1. Pro: The Covid-19 Case Fataility Rate \(CFR\) is [greater](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext)(The presentation of patients with COVID-19 and seasonal influenza requiring hospitalisation differs considerably. Severe acute respiratory syndrome coronavirus 2 is likely to have a higher potential for respiratory pathogenicity, leading to more respiratory complications and to higher mortality.) than the influenza CFR.
1.7.5.3.2. Con: At the beginning of the Covid-19 pandemic, only Italy \(and Spain\) were [reporting extremely high death rates](https://coronavirus.jhu.edu/map.html). They were the statistical outliers and did not represent the overall global condition.
1.7.5.3.2.1. Con: They are the statistical outliers in large part because their uncontrolled outbreaks started [earlier](https://euobserver.com/coronavirus/147932) than elsewhere. They're better characterised as a leading indicator than an outlier.
1.7.5.3.2.1.1. Con: [Germany had its first case on 27.01.2020](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Germany), [Spain had its first case on 31.01.2020](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Spain), [Italy had its first case on 31.01.2020](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy). Despite Germany's early start, Germany's death rate was [much lower](https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..&country=DEU~ITA~ESP&hideControls=true&Metric=Case+fatality+rate&Interval=Cumulative&Align+outbreaks=true&Relative+to+Population=false) at the beginning of the pandemic.
1.7.5.3.2.1.1.1. Con: Germany [started testing early and aggressively](https://www.theguardian.com/world/2020/apr/02/coronavirus-testing-how-some-countries-germany-south-korea-got-ahead-of-the-rest), resulting in a significantly greater rate of case detection, and in turn, better isolation of infected cases. As a result, due to better detection of cases in Germany, Italy [passed 1000 cases on 1 March](https://ourworldindata.org/grapher/total-cases-covid-19?country=DEU+ITA+ESP), while Germany still had just over 100 cases. This is why, despite when first cases were reported, Italy's uncontrolled outbreak started earlier than Germany's.
1.7.5.3.2.1.1.1.1. Con: According to the parent claim, after Germany, Italy had done the most testing as of March 2020, with about [200,000 tests](https://www.theguardian.com/world/2020/apr/02/coronavirus-testing-how-some-countries-germany-south-korea-got-ahead-of-the-rest). Italy has 20 million less people than Germany, and it has a high ratio of tested per million Italians.
1.7.5.3.2.1.2. Con: There are multiple other reasons why Spain and Italy could have been outliers early in the pandemic. For example, air pollution, quality of health infrastructure, age of population, consumption of anti-inflammatory drugs, population tested, test kits used, ways test kits were used, way of defining Covid-19 causality of death, etc.
1.7.5.3.2.1.2.1. Pro: -> See 1.7.5.2.1.
1.7.5.3.2.1.3. Pro: Because Covid-19 fatalities are not immediate following infection, it takes time for cases that will ultimately be fatalities to show up in the death data.
1.7.5.3.2.1.3.1. Pro: -> See 1.7.5.1.1.
1.7.5.3.2.1.3.2. Pro: In the week from March 30 to April 5, 2020, Germany's fatality rate nearly doubled, [rising from 0.79% to 1.46%](https://ourworldindata.org/grapher/coronavirus-cfr?time=40..75&country=DEU).
1.7.5.3.2.1.4. Con: Early in the pandemic, the fact that the Covid-19 related death rate doubled for Germany still discredits the idea of Italy and Spain as leading indicators, as [4.54%](https://ourworldindata.org/grapher/coronavirus-cfr?time=2020-03-01..&country=DEU~ITA~ESP) in Germany is far below the Italian and Spanish rates. Italy and Spain can still be considered as outliers and not leading indicators.
1.7.5.3.2.1.5. Pro: The fact that Covid-19 spread to [every country in the world](https://www.worldometers.info/coronavirus/countries-where-coronavirus-has-spread/) throughout 2020 indicates that Italy and Spain were leading indicators rather than outliers.
1.7.5.3.2.2. Pro: Italy is knowingly an outlier in Europe when considering the influenza epidemic, where it is conceded that [excess mortality rate is higher due to older population](https://www.ijidonline.com/article/S1201-9712\(19\)30328-5/fulltext).
1.7.5.3.2.3. Con: Taking the flu death average per day across several seasons and years gives a skewed picture and cannot be compared with a smaller Covid-19 time sample.
1.7.5.3.2.4. Pro: At the [beginning of April](https://coronavirus.jhu.edu/map.html) 2020, Italy reported 13,000 Covid-19 deaths, followed by Spain at 9,000. [Most countries did not report a similarly high rate](https://ourworldindata.org/coronavirus#confirmed-covid-19-deaths-by-country) at the time.
1.7.5.4. Pro: [Germany](https://edition.cnn.com/2020/03/24/opinions/germany-low-death-rate-for-coronavirus-sepkowitz/index.html)'s Covid-19 death rate was low in March 2020.
1.7.5.4.1. Pro: As of April 2021, Germany's death rate from Covid-19 was [lower](https://ourworldindata.org/explorers/coronavirus-data-explorer?tab=map&zoomToSelection=true&time=latest&pickerSort=desc&pickerMetric=total_cases&hideControls=true&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=true&Align+outbreaks=false&country=IND~USA~GBR~CAN~DEU~FRA) than many of its European neighbors.
1.7.5.5. Con: Global variances are to be expected since different governments respond to the pandemic differently.
1.7.5.5.1. Pro: According to the results of a [preprint](https://www.medrxiv.org/content/10.1101/2020.07.04.20145334v1), the type of policies enacted by governments impacted the number of deaths by Covid-19.
1.7.5.6. Con: This is irrelevant since the death rate of Covid-19 is still higher than that of the flu.
1.7.6. Con: Death rate for Covid-19 cannot be accurately estimated due to inadequacies in data.
1.7.6.1. Con: Since the virus emerged, numerous [estimations](https://ourworldindata.org/mortality-risk-covid) of Covid-19 death rates have been made, becoming increasingly accurate over time.
1.7.6.2. Pro: Not all people who are infected with the Covid-19 virus are identified. This makes it challenging to calculate the actual [fatality rate](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524446/).
1.7.6.2.1. Pro: The [case fatality rate](https://www.newscientist.com/article/2239497-why-we-still-dont-know-what-the-death-rate-is-for-covid-19/) of Covid-19 is a function of how many people are tested. Since the extent of testing varies from one country to another, it is difficult to estimate the actual global fatality rate.
1.7.6.2.1.1. Pro: Accurate fatality rates for Covid-19 will only be possible after widespread [antibody testing](https://www.newscientist.com/article/2238477-how-does-coronavirus-testing-work-and-will-we-have-a-home-test-soon/).
1.7.6.2.1.1.1. Pro: [Antibody testing](https://www.newscientist.com/article/2238834-will-a-home-antibody-test-for-covid-19-really-be-a-game-changer/) can give a more accurate estimate of how many people were infected in the past and able to recover.
1.7.6.2.1.2. Pro: Asymptomatic Covid-19 patients are in most cases not [tested](https://www.nature.com/articles/s41467-020-18272-4); therefore, the current calculated death rates could be wrong.
1.7.6.2.1.2.1. Pro: When sample populations are tested and monitored over an extended period, as many as [28% of cases](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241536)(among nursing home residents, the proportion was 54% \(42% to 65%\) of which 28% \(13% to 50%\) remained asymptomatic through follow-up) were asymptomatic for the entire period of illness.
1.7.6.2.1.2.1.1. Con: The number of asymptomatic cases cannot be seriously estimated at the beginning of a pandemic as a statistical study would be necessary by having a representative sample of the population tested once the pandemic is over. That way, it is easier to assess who had it without knowing it, who had it and did have the symptoms, and who had it and most probably died from it.
1.7.6.2.1.2.2. Pro: It is plausible that a country that is mostly only testing severely ill people will show a higher [case fatality rate](https://www.nature.com/articles/s41598-020-75848-2) than a country testing more widely.
1.7.6.2.1.2.3. Pro: The actual Covid-19 death rate must be estimated based on a calculated excess mortality rate, as not all Covid-19 infected persons are being tested, but only a selected subset of them.
1.7.6.2.1.2.3.1. Con: Based on early reporting figures and adjustments for reporting delays, various countries with significant outbreaks are already seeing [significant excess mortality](https://www.euromomo.eu/graphs-and-maps#excess-mortality).
1.7.6.2.1.2.3.1.1. Pro: Indeed, based on monitoring of excess mortality in Italy, [death figures may be significantly underestimating the number of deaths due to Covid-19](https://www.bloomberg.com/opinion/articles/2020-04-01/coronavirus-italy-shows-we-may-be-underestimating-death-toll).
1.7.6.2.1.2.3.1.2. Pro: The death count in Spain was found to be [70% higher](https://www.reuters.com/article/health-coronavirus-spain-idUSL8N2IQ308) than official records showed from March to May 2020.
1.7.6.2.1.2.3.1.3. Con: An interpretation of the observed excess mortality numbers should also be cautiously done, as the quarantine measures do have an impact on [the mortality rate.](https://translate.google.com/translate?sl=auto&tl=en&u=https%3A%2F%2Fwww.ruhr24.de%2Fdortmund%2Fcoronavirus-dortmund-isolation-professor-walter-kraemer-warnung-kontaktverbot-nrw-uni-zr-13630065.html)
1.7.6.2.1.2.3.1.3.1. Con: While there are reasonable concerns about long-term increases in mortality due to economic deprivation and reduction in physical fitness or mental health, those are things that would impact long-term mortality, and not contribute to excess mortality in any given week.
1.7.6.2.1.2.3.1.3.1.1. Pro: The impact of long-term negative effects of lockdowns \(depression, obesity, poverty, etc.\) on mortality rates are also possibly offset by reduction of mortality due to [crime](https://www.mirror.co.uk/news/uk-news/huge-drop-crime-during-covid-22917722) and [suicide](https://www.bbc.co.uk/news/health-56818876) during lockdowns.
1.7.6.2.1.2.3.1.3.2. Con: In the short term, aggressive isolation measures are likely to reduce deaths from non-Covid causes as well.
1.7.6.2.1.2.3.1.3.2.1. Pro: People aren't driving or walking near busy roads, thereby preventing traffic accidents.
1.7.6.2.1.2.3.1.3.2.1.1. Con: One study [found](https://www.economist.com/graphic-detail/2021/04/03/americans-are-driving-less-but-more-are-dying-in-accidents) that even though Americans are driving less, traffic fatalities actually increased as more people drove recklessly on emptier roads.
1.7.6.2.1.2.3.1.3.2.2. Pro: Other communicable diseases are also prevented from spreading when taking precautions against Covid-19 transmission.
1.7.6.2.1.2.3.1.3.2.2.1. Pro: One study found that influenza infection rates were "[historically low](https://www.cdc.gov/mmwr/volumes/69/wr/mm6937a6.htm)" during the Covid-19 pandemic.
1.7.6.2.1.2.3.1.3.3. Pro: Financial distress, domestic violence, suicide, and [the consequences of isolation](https://journals.sagepub.com/doi/abs/10.1177/1745691614568352) are proven to increase the mortality risk.
1.7.6.2.1.2.3.1.4. Pro: Throughout the pandemic, countries around the world experienced [above average excess mortality](https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker).
1.7.6.2.1.3. Pro: In the US, Covid-19 testing [has not been](https://www.livescience.com/coronavirus-testing-us-states.html) as rigorous or as consistent across states as it has been in other countries.
1.7.6.2.1.3.1. Con: This is a good reason to discount the US mortality data, but not a good reason to discount mortality data from countries with significantly better testing regimens, like [South Korea](https://abcnews.go.com/Health/trust-testing-tracing-south-korea-succeeded-us-stumbled/story?id=70433504).
1.7.6.2.1.3.2. Con: As of March 26, 2021, the US has [conducted](https://www.worldometers.info/coronavirus/) nearly 400 million tests, more than any other country.
1.7.6.2.1.3.3. Pro: There have [not been enough](https://www.livescience.com/coronavirus-testing-us-states.html) Covid-19 tests in the US. Therefore, many people have not been able to confirm or deny having been infected by the virus.
1.7.6.2.2. Pro: Insufficient tracking makes it challenging to estimate the extent of Covid-19 [reinfections](https://www.statnews.com/2021/04/07/covid-19-reinfections-still-seem-rare/).
1.7.6.2.2.1. Con: As of January 2021, [Covid-19 reinfections](https://www.bmj.com/content/372/bmj.n99) appear to cause milder infections and therefore are unlikely to add significantly to the death rate.
1.7.6.2.3. Con: Inadequate testing suggests that the actual fatality rate is [higher](https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker) than reported and not lower. This further entails that it is deadlier than the flu .
1.7.6.3. Con: Even without accurate rates, the possible range of the [fatality rate](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600\(20\)30527-0/fulltext) strongly indicates that Covid-19 is deadlier than the seasonal flu.
1.7.6.3.1. Con: As flu viruses undergo mutations, it is difficult to make predictions about the rate of death. In Italy, the total number of flu-related deaths during the 2014-2015 season was 65.6% higher compared to the [previous season.](https://www.ijidonline.com/article/S1201-9712\(19\)30328-5/fulltext)
1.7.6.3.1.1. Con: Mutations often lead to [an increase](https://economictimes.indiatimes.com/magazines/panache/novel-coronavirus-can-undergo-mutations-that-may-make-it-more-deadly-contagious-says-study/articleshow/78997408.cms?from=mdr) in the number of deaths. By that trend, mutations could make Covid-19 even more dangerous than it already is.
1.7.7. Pro: Among [immunocompromised](https://www.nature.com/articles/s41598-021-85081-0) patients, those with Covid-19 had a higher mortality compared to those with influenza.
1.7.7.1. Con: The formerly developed Flu Pandemic Severity Index classifies the flu's "dangerousness" \(severity\) in [5 categories](https://www.cdc.gov/media/pdf/MitigationSlides.pdf) ranging from a death rate lower than 0.1% to more than 2%. In that sense, Covid-19 is not more and not less dangerous, but fits the definition.
1.7.7.1.1. Con: The Flu PSI is outdated and has been replaced by the [Pandemic Severity Assessment Framework](https://www.cdc.gov/flu/pandemic-resources/national-strategy/severity-assessment-framework.html) \(PSAF\).
1.7.7.1.2. Con: The only time that the flu met the threshold for Category 5 was during the [1918 influenza pandemic.](https://en.wikipedia.org/wiki/Pandemic_severity_index) This is thus an exception rather than the rule.
1.7.8. Con: -> See 1.4.5.2.9.2.
1.7.9. Pro: Covid-19 outbreaks also cause [indirect deaths](https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker) by using up medical resources that would have been used to treat other fatal conditions.
1.7.9.1. Pro: Covid-19 restrictions meant that many non-emergency procedures, including cancer screenings, were [postponed](https://www.bbc.com/future/article/20200528-why-most-covid-19-deaths-wont-be-from-the-virus)(Across the globe, patients have reported being denied cancer care, kidney dialysis and urgent transplant surgeries, with sometimes fatal results.), leading to excess deaths indirectly related to Covid-19.
1.7.9.1.1. Pro: Experts predict that [60,000 people](https://www.itv.com/news/2020-04-22/60-000-cancer-patients-could-die-because-of-lack-of-treatment-or-diagnosis-oncologist-on-coronavirus-dilemma) will die from cancer as a result of delayed treatment or diagnosis in the UK alone.